PediatricPediatricA Fun & Fact-Filled Newsletter from the University of Maryland Children’s Hospital

As one of the most common conditions in children, it’s impor-tant that parents are informed about asthma. “Asthma can really impact a family’s life,” says Lisa Bell, CPNP, AE-C, Pediatric Nurse Practitioner and Certified Asthma Educator at the Univer-sity of Maryland Children’s Hospital Breathmobile Program. “It’s one of the most common reasons kids go to the emergency department, are admitted to the hospital, and also one of the biggest reasons kids miss school. But, all of those things can be prevented by working with your child’s healthcare provider to come up with a treatment plan specific to your child.”

SymptomSGetting started on the right treatment plan begins with a diagnosis. Many parents think of an ‘attack,’ or an inability to breathe, when they think of asthma, but asthma symptoms can vary from child to child. “Common asthma symptoms include coughing, wheezing, shortness of breath, and chest tightness,” explains Bell. “These symptoms often occur at night, or in response to exercise.” Children may have asthma without having all of these signs, and it is important to keep in mind that a persistent cough could be the only symptom in some children. Anytime there are repeated episodes of these symptoms, it is important to discuss them with your child’s provider. (Read more about asthma and nighttime symptoms on page 4.)

Asthma 101: What you need to know

HEY KIDS!How many can you find?

See how many hidden

logos you can find in

each Pediatric Press!

This is a special issue of Pediatric Press devoted to keeping asthma on the move!

www.umm.edu/pediatrics 1.800.492.5538

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This is a special issue of Pediatric Press dedicated to breathing easy

and keeping on the move!

If you have ever spotted a large recreational vehicle decorated

with colorful pictures of children, you’ve more than likely seen

the University of Maryland Children’s Hospital Breathmobile! The

Breathmobile is a custom-built pediatric asthma clinic that travels

to different schools in the Baltimore area — delivering long-term,

preventive care to kids in their own community.

Our first Breathmobile — which was also the first Breathmobile on

the East Coast — took to the roads in 2002! In late spring 2013,

we welcomed a new Breathmobile, thanks to a generous grant from

Kohl’s Cares. By partnering with Kohl’s, we have helped thousands

of children stay healthy! Just last year, the Breathmobile team cared

for more than 500 children in more than 1,000 visits at local schools.

Asthma is a huge problem in Baltimore, which is why we and our partner,

Kohl’s, have decided to devote this issue of Pediatric Press exclusively to

asthma. There is no cure for asthma, but that does not mean it should stop

children from playing, going to school and breathing easy. Read through the

articles in this issue and become more familiar with asthma.

Here’s to your health.

Steven J. Czinn, MD

Valuable information is just a click away at umm.edu/pediatrics! Or by phone at 1.800.492.5538.

The brand new Breathmobile was unveiled at Mary Ann Winterling Elementary School in late Spring 2013 on a hot day before a group of cool students!

Together, UM and Kohl’s are keeping asthma on the move!

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Dear families,

Steven J. Czinn, MDChief of Pediatrics, University of Maryland Children’s Hospital; Professor and Chairman, Department of Pediatrics, University of Maryland School of Medicine

fall / winter

Asthma 101: What you need to know ... continued from page 1

cauSeSNo one really knows exactly what causes asthma. Family history of asthma can increase a child’s risk as can environmental factors. “You see a much higher rate of asthma in urban settings,” says Bell. “Exposure to things like tobacco smoke or allergens can play a role in the severity and development of asthma. While there is no cure for asthma, it can be controlled with the right medications as well as learning how to avoid triggers.”

An asthma trigger is something that can cause a person to have asthma symptoms or an asthma attack. Asthma triggers can vary from person to person, but some of the most common ones include upper respiratory infections, weather change, allergies, smoke and exercise. “It is very important for children to under-stand how to avoid triggers,” adds Bell.

treatmentAsthma is a chronic condition which can be controlled. Asthma causes changes in the airways causing the muscles to contract, resulting in symptoms such as chest tightness, shortness of breath, coughing and wheezing. The two types of medications used to treat asthma include “controller” medications that treat the inflammation in the airway to prevent symptoms and “quick-relief” medications that are used as needed for symptoms caused by the airway muscle constriction.

“A controller is a medication that your child takes every single day, even if they are feeling well and not experiencing symp-toms,” explains Bell. These medications prevent symptoms before they occur by treating the swelling inside the airways.

The other type of medication that everyone with asthma should have is a “rescue” or quick-relief medication. Generally a quick-relief medication can alleviate acute asthma symptoms such as coughing, wheezing or chest pains and is only used as-needed when symptoms occur. If your child’s asthma is controlled, you shouldn’t need to use quick-relief medication very often. It is, however, important to have it on hand in case of an emergency.

When to call 911You should seek immediate medical attention if your child shows signs of respiratory distress including struggling to breathe, difficulty speaking in sentences, chest retractions (sucking in of the chest or ribs), flaring of the nose, blue lips and/or shortness of breath. These are commonly referred to as an asthma attack. “Don’t wait if you’re concerned about your child’s breathing,” urges Bell. You should also seek medical attention if your child’s quick-release medication is not relieving symptoms or if it is not lasting for at least 4 hours.

Keeping Asthma on the Move

Hop on board the Breathmobile where pediatric nurse practitioner Lisa Bell delivers ongoing care to children with asthma.

The University of Maryland Children’s Hospital has taken an innovative approach to tackling Baltimore’s high prevalence of asthma through the creation of our Breathmobile Program. “The Breathmobile is a mobile asthma clinic that provides prevention care at various Baltimore City schools and Head Start Centers to bring asthma diagnosis and treatment to children who are most in need of our services,” says Mary Beth Bollinger, DO, associate professor of pediatrics and medical director of the Breathmobile.

“Kids in underserved areas often don’t have access to good, specialty asthma care for a variety of reasons,” says Lisa Bell, NP. “So we go to them.”

The Breathmobile includes Bell as a pediatric nurse practi-tioner as well as a pediatric allergist, certified nursing assistant and a driver. On the Breathmobile, children undergo an asthma-focused history and physical, including lung-function testing and allergy skin testing. Then a treatment plan is given to families so children stay healthy and in school. The Breathmobile is a free program available to all children ages 2 to 18 regardless of what school they attend and whether or not they have health insurance.

To find out more about the Breathmobile or for information on supporting the program, call 410.706.4000 or visit us online at playhardbreatheeasy.com for a list of schools and scheduled visits. The site also includes links to educational information if you want to learn more about asthma.

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www.umm.edu/pediatrics 1.800.492.5538 3

Asthma is the most common chronic con-dition in children. “It affects about 1 in 10 kids,” notes Anayansi Lasso-Pirot, MD, pediatric pulmonologist. “And it’s also the most common reason for children to be admitted to the hospital.”

But despite how common it is, parents often don’t recognize symptoms of asthma in their children. Many people associate wheezing with asthma, but not coughing. Yet it’s often a chronic nighttime cough that leads to a diagnosis of asthma in children.

diSrupting Sleep Chronic nighttime cough is typical of un-controlled asthma, and may disrupt sleep, leading to school absenteeism. The cough may occur even when the child isn’t having an asthma attack. “It might not be every night, but it will be frequent enough

Is your child losing sleep because of a chronic nighttime cough?

that it definitely interrupts the quality of sleep,” says Dr. Lasso-Pirot, an assistant professor of pediatrics. “It is a common problem in asthmatics. Parents should not accept a chronic cough in their child as a normal occurrence. Consider it a problem and seek medical advice. It’s a really com-mon presentation of uncontrolled asthma.

“A chronic cough is defined as a cough that lasts longer than two months,” she adds. “Chronic cough is unlikely to be the only symptom of asthma, but it might be the predominant one. The child may have some shortness of breath with exercise, too, but it may not be that noticeable.”

Asthma is a chronic disease that narrows the airways. Since children have smaller airways than adults, it can be especially serious for them. “Also, asthma attacks tend to be worse at night,” Dr. Lasso-Pirot explains. “In a normal pattern of breathing,

there is a drop in airflow in the middle of the night. If you have an asthma attack, it’s more apparent because there’s a more severe reduction in airflow.”

finding reliefAsthma is usually treated with two types of medications — a long-term anti-inflam-matory used to prevent symptoms and a quick-acting medication to stop asthma attacks. “With proper control of asthma, symptoms like chronic nighttime coughing or exercise-induced coughing or wheezing usually disappear or become extremely rare,” Dr. Lasso-Pirot states.

The University of Maryland Children’s Hospital uses a team approach to treating pediatric asthma patients. The team of specialists may include allergists, pulmonologists, respiratory therapists and gastrointestinal specialists. About 80 percent of children’s asthma cases are

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triggered by allergies, and some cases are triggered by reflux disease.

“Asthma is a chronic condition, so it needs continual follow-up, and that’s what we do,” notes Dr. Lasso-Pirot.

If your child is losing sleep because of a chronic cough, it’s time to call for an appointment. Contact the Division of Pediatric Pulmonology and Allergy at 410.706.2443.

Meet Anayansi Lasso-Pirot, MD, pediatric pulmonologist

Anayansi Lasso-Pirot, MD, is a pediatric pulmonologist fluent in English and Spanish, with a working knowledge of spo-ken French. She earned her medical degree at the University of Panama School of Medicine and completed a residency in pediatrics at Monmouth Medical Center in New Jersey. She completed fellowships in pediatrics and pulmonology at St. Christopher’s Hospital for Children in Pennsylvania.

She is board certified in pediatrics and pediatric pulmonology, and has special interests in the care of infants and children with chronic lung diseases, diagno-sis and management of aspiration syndromes in children, and asthma and other chronic lung diseases affecting Latino-American children.

Dr. Anayansi Lasso-Pirot was named one of Baltimore Magazine’s 2010 “Top Docs” for Pediatric Pulmonology.

Parents should not accept a chronic cough in their child as

a fact of life. Consider it a problem and seek medical advice.

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(Answers below)

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ANSWERS: 1. fruit; 2. vegetables; 3. book; 4. sleep; 5. soccer ball.

Say it in SPANISH!

(That means “good luck” in Spanish!)

¡Buena suerte!

fruitivaverduras

balón de fútbol

el libro

dormir ¡Hola! Do you know any words in Spanish? The words in this game lead to good health

and strong minds and bodies. Look for clues and fill in the blanks.

ZZZZZZ Z

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If your child has asthma, you’re already familiar with the coughing, wheezing and chest tightness that occur during attacks. About 10 percent of all American children have been diagnosed with the chronic condition, but parents sometimes underes-timate how dangerous asthma can become when it’s uncontrolled — which can happen in resistant cases or when medications aren’t taken as prescribed or with continued exposure to environmental triggers.

“Asthma is among the most common reasons for admission to the Pediatric Intensive Care Unit (PICU),” says Jason Custer, MD, an assistant professor of pedi-atrics at University of Maryland Children’s Hospital. “It’s a small percentage of the number of children who have asthma, but those children who come to the PICU are at high risk for complications from asthma or even dying from their asthma.”

Nationwide, about 16 percent of all patients admitted to a hospital for asthma require ICU care, according to Dr. Custer, and about 1 in 2,000 die while hospitalized.

A major PICU upgrade underway at UMMC will offer every patient a private room with sleeping accommodations for parents, Dr. Custer says.

“Often our asthma patients are school-age children who are awake and alert, and sharing space with another sick person is not ideal,” he adds.

managing medication uSeMost children with asthma are prescribed a combination of two types of drugs, including controller medications such as inhaled steroids, which treat inflammation in the lining of the bronchial tubes; and quick-relief or “rescue” medicines such as inhaled albuterol to relax broncho-

Controlling children’s asthma is crucial

spasms from muscles tightening around the bronchial tubes.

Controller medications should be taken daily to prevent asthma symptoms and quick-relief medicines are used as needed for a persistent cough, wheezing or short-ness of breath. But sometimes parents are confused about which medication should be taken and when, Dr. Custer says, which can lead to uncontrolled asthma.

“Often when we interview parents we learn they’re not using their children’s controller medications effectively, or that they thought they didn’t need the control-ler medication because their child had no symptoms,” Dr. Custer explains. “Sometimes parents take the liberty of discontinuing their child’s controller medications, not understanding how serious the consequences can be. Often incorrect inhaler technique can also impact asthma control.”

KnoW the triggerSAnother key to managing asthma is to know your child’s asthma triggers, which can include allergens such as dust mites, pollen, mold, furred animals or irritants such as smoke and perfume. Upper respi-ratory infections, exercise and changes in the weather can also be asthma triggers. Parents should partner with their primary care doctor or asthma specialist to write out an asthma action plan that details the

child’s specific triggers, pattern of symp-toms and necessary medications, distribut-ing this plan to teachers, coaches, school nurses and other adults involved in the child’s daily care.

“If parents are consistent about having their child use their control medication, they can often blunt the severity of the situation by having the baseline asthma under controller,” Dr. Custer says. “If they have to use the rescue medication more than twice a week, it’s a sign their child’s asthma is not well-controlled.”

Inside the PICU, Dr. Jason Custer and the team care for kids who have uncontrolled asthma.

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Who Loves to Color?If you do, enter our coloring contest and get a chance to win a $20 Target® gift card by coloring Turbo, our mascot. You can submit a scan of your completed artwork to coloringcontest@umm.edu or mail your picture to:

Coloring Contest, C/O MarketingUniversity of Maryland Children’s Hospital110 S. Paca Street, 8th FloorBaltimore, MD 21201

You can also find more blank copies of this coloring page at umm.edu/coloringcontest.

Deadline for entry is Nov. 15, 2013.

Winners will be awarded in two age groups: 1 to 8 years, and 9 to 14 years. The winners will be notified by mail.

entry formPlease enter my picture in your Turbo the Mascot coloring contest.

Name ____________________________________________________________________

Address ___________________________________________________________________

City/State/ZIP ______________________________________________________________

Age category (check one):

____ 1 to 8 years ____ 9 to 14 years

www.umm.edu/pediatrics 1.800.492.5538 7

How many did you find?

We found 14

A special thanks to Kohl’s for

their continual support of our

asthma initiatives. Together,

we are ensuring children

breathe easy as we keep

asthma on the move!

Below you’ll find names of painters and details about some of the paintings they’re famous for. Match each artist with one of the clues and write the letter next to the painter’s name.

Answers: 1. B, 2. A, 3. D, 4. E, 5. F, 6. C

1. Leonardo da Vinci

2. Georgia O’Keefe 3. Michelangelo

6. Vincent van Gogh

5. Andy Warhol4. Frida Kahlo

ArtistArtistMona Lisa

B.

D.

A. Flowers and New Mexico landscapes

Famous worksFamous works

The ceiling of the Sistine Chapel at the Vatican in Rome, Italy

Starry nights and sun�owers

C.

E. Self-portraits

Campbell’s®

soup cans

F. Scoring6 correct: Stroke of genius3-5 correct: You’re art smart2 or fewer correct: Brush up on your knowledge of painters

For more information about the newsletter, please e-mail abessent@umm.edu. To learn more about the Children’s Hospital, please log on to umm.edu/pediatrics or call 1.800.492.5538.

Steven J. Czinn, MD Professor and Chairman, Department of Pediatrics

Alison G. Brown, MPHSenior Vice President,Planning, Marketing &Business Development

Mary Taylor, MS, RNDirector of Nursing, Women’s & Children’s Services

Alexandra BessentEditor, Pediatric Press

Pediatric Press is an information service of the University of Maryland Children’s Hospital and published by the University of Maryland Medical Center.

This publication does not constitute professional medical advice. Although it is intended to be accurate, neither the publisher nor any other party assumes liability for loss or damage due to reliance on this material. If you have a medical question, consult your medical professional. Websites not belonging to this organization are provided for information only. No endorsement is implied. Images may be from one or more of these sources: ©Thinkstock, ©Fotolia, ©iStock. ©2013 University of Maryland Children’s Hospital.

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